Rural Project Examples Addressing Service delivery models

Updated/reviewed March 2024

Need: In Vermont, the growing population of older adults, coupled with a lack of a decentralized, home-based system of care management, poses significant challenges for those who want to remain living independently at home.
Intervention: SASH® (Support and Services at Home), based in affordable housing and their surrounding communities throughout the state, works with community partners to help older adults and people with disabilities receive the care they need so they can continue living safely at home.
Results: Compared to their non-SASH peers, SASH participants have been documented to have better health outcomes, including fewer falls, lower rates of hospitalizations, fewer emergency room visits, and lower Medicare and Medicaid expenditures.

Updated/reviewed March 2024

Need: To prevent new cases of HIV in rural Iowa.
Intervention: TelePrEP provides preventive care via telehealth and prescription delivery.
Results: Between February 2017 and August 2020, TelePrEP received 456 referrals, with 403 patients completing an initial visit.

Updated/reviewed December 2022

Need: To coordinate formal and informal community-based caregivers for optimal patient experience.
Intervention: The Maryland Faith Health Network unites places of worship and healthcare systems in Maryland. This program aims to decrease the amount of potentially avoidable hospitalizations, improve a patient's overall wellness, and cut down on the cost of medical services.
Results: This model is currently running in 3 hospitals that serve both rural and urban residents in central Maryland. So far, 1,300 congregants from 70 congregations representing Christian, Jewish, and Muslim faiths have enrolled in the Network.

Updated/reviewed November 2022

Need: To properly address and treat patients who have concurrent substance use and chronic healthcare issues.
Intervention: A referral system utilizes community health workers (CHWs) in a drug and alcohol treatment setting. A registered nurse helps with providers' medication-assisted treatment programs.
Results: This program has reduced hospital emergency visits and hospital readmissions for patients since its inception.

Updated/reviewed August 2022

Need: Ways to reduce hospital admission rates, emergency department visits, and total cost of care while better accommodating patients of the Atlantic General Hospital Corporation.
Intervention: The hospital system applied a patient centered medical home care model to their 7 rural outpatient clinics located throughout the Eastern Shore of Maryland and southern Delaware.
Results: From the program's care coordination, care transitions, and intervention efforts, AGH saw improvements in quality-of-care processes, service use, and spending.

Updated/reviewed August 2020

Need: To increase local health services to rural elderly populations in long-term care facilities located in four Midwest states near a tertiary care organization.
Intervention: A non-profit healthcare organization implemented telehealth services to provide acute care evaluations for long-term residents in their home facilities.
Results: The program increased local care as evidenced by improved year-over-year provider-determined available transfer data: 33%, 50%, 63% program years 1 through 3, respectively. From the success of the initial pilot implementation, the program has further matured into a long-term care offering that now reaches many other rural facilities located in 10 states across the nation.

Updated/reviewed May 2020

Need: To reduce the prevalence of diabetes and cardiovascular disease in rural Colorado.
Intervention: Community Health Workers are utilized to create a system of coordinated care in Delta, Montrose, Ouray, and San Miguel counties.
Results: As of 2018, 2,709 people have been screened for diabetes and cardiovascular disease, with many at-risk patients lowering cholesterol, blood pressure, and A1C levels after engaging with a Community Health Worker.

Updated/reviewed April 2020

Need: Allow rural cancer patients in a region inclusive of 26 counties in Iowa, Minnesota, and South Dakota to have access to tertiary-level chemotherapy regimens in rural infusion centers.
Intervention: With telehealth-based oversight from a tertiary care oncology team, 3 rural infusion teams were trained to coordinate cancer treatment plans and administer complex chemotherapy regimens.
Results: Almost 130 patients were transitioned to receive chemotherapy in a rural infusion center, translating to over 1,000 infusion visits and saving patients/families nearly 65,000 trip miles, 1,800 travel hours and $71,000.

Updated/reviewed June 2024

Need: Clinicians in rural and underserved areas are often unprepared to provide comprehensive medical-forensic examinations for patients who present for care following a sexual assault.
Intervention: The MDPH TeleSANE Center uses secure telehealth software to connect sexual assault nurse examiners to clinicians and patients in hospitals across Massachusetts — including four in rural counties — offering expert clinical guidance and support before, during, and after examinations.
Results: Clinicians report that the service gives them increased confidence throughout the examination process. To date, the MDPH TeleSANE Center has assisted in the care of over 960 patients.

Added May 2024

Need: To expand healthcare access in rural Alabama communities.
Intervention: The Auburn University Rural Health Initiative is working with communities across Alabama to develop a healthcare model that includes primary care, substance use disorder treatment and mental health treatment via state-of-the-art telehealth technologies, coupled with health and wellness programs and services provided by faculty and students.
Results: The first telehealth care station, located in LaFayette, Alabama, began offering services in April 2023. Within the first year after opening, clinicians in the telehealth station conducted 592 patient consultations and issued 720 prescriptions.

Rural Project Examples: Service delivery models